Urachal sinus (US) is a rare congenital abnormality resulting from the improper involution of embryological tissues connecting the bladder to the umbilicus. It typically presents in childhood but can remain asymptomatic into adulthood.
A 70-year-old male with hypertension and dyslipidemia presented with periumbilical pain, swelling, and purulent discharge. Initial empirical treatment with antibiotics was ineffective. Further imaging revealed fluid collections consistent with an infected urachal sinus. Surgical drainage and subsequent elective umbilical amputation with herniorrhaphy and hernioplasty resulted in full recovery, with no recurrence of symptoms. This case report highlights the diagnostic challenges posed by its non-specific clinical presentation and emphasizes the need for awareness of urachal anomalies in adults presenting with recurrent omphalitis. Early diagnosis and appropriate surgical management are essential for successful outcomes.